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Dublin: 6 °C Friday 21 February, 2020
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Column:“I'm sorry, there are no doctors” - what it's like to work in an understaffed Emergency Department

Overworked staff, backlogs of patients, and an extreme lack of experienced Consultants. Dr Bríd McGrath talks about the struggle involved in working in one of Ireland’s busiest Emergency Departments.

Dr Brid McGrath

I AM A Senior House Officer. That’s a doctor who graduated at least one year ago. Senior House Officer is a stepping stone: you can work at this level for two years or ten years, depending on whether you get training or not. An S.H.O. handles a good deal of first contact work with patients, but in these situations it is always wise, and often necessary, to seek advice from a Registrar or a Consultant.

I work in one of the busiest Emergency Departments in Europe, and this year we only have four out of the required seven Registrars needed working here. These four doctors are my heroes: if they did not come to work, the wounded and dying would literally line the streets – I am not joking. There are three more available Registrar posts but, as of yet, no-one wants these jobs.

In an Emergency Department there are four categories of patients: Majors (very ill adults), Minors (fractures & wounds), Paediatrics (all major and minor children) and the “Resus” (patients who are at imminent risk of death, and need immediate resuscitation). In an ideal world, there would be a senior doctor and an S.H.O for each of these areas. In the real world, we often have half, or less than half, this number of doctors.

We Senior House Officers are not fit for all purposes.

Effects on the patients

Last Saturday night I left work in the Paediatrics room two hours after my shift ended. The nurse was left to look for a doctor to take over Paediatrics after I had already clocked two extra hours… Hours for which I know I won’t be paid.

I felt satisfied that the children I had seen had been properly taken care of.  However, as I was leaving, a man approached me with his five-year-old daughter in his arms, asking me when she was going to be seen. He had arrived at 2.30pm… At this stage it was almost 8pm. Looking at the in-tray I saw that there were nine cases pending; at least six of which had arrived before 3pm. Emptying that in-tray was like trying to empty the ocean with a bucket.

What did I say to that man?

“I’m sorry, there are no doctors”.

No, seriously, I did.

Overworked staff

Why didn’t I go back, clock more free hours and help all of those children? If I did, I would have never got home. I would be giving HSE more of what it’s currently thriving on: overworked doctors filling in the gaps, for the lack of competence involved in providing an adequate staffing. So we let the children wait. We let the public call radio stations and give out about their hours waiting in hospitals. We let the truth come out.

That night after working in Paediatrics, I went home and cried. After only two weeks in the Emergency Department, this was the third time that I had cried. All day, every day, people give out to me about waiting, about the lack of doctors, and about not getting beds. I don’t have to ask why the other three Registrar posts aren’t filled.

False perceptions of Consultants

The public’s perception of Consultants is that they are ‘absentee landlords’, cashing in a lot of money for very little work. Sure, there may be a few who do fit this assumption – but certainly in the public sector, it is the Consultants who I’ve seen clocking in serious hours, struggling to keep this show on the road. They teach us, they keep their cool under pressure, and most importantly, they provide a safety net of knowledge and experience. As a Senior House Officer, I need their experience. There may be people in Ireland who would say that we don’t need Consultants, but I would argue that there isn’t a single working doctor who thinks this.

It is the Consultants who try to fight for better resources, and for more staff. Recently one of our Emergency Department Consultants phoned to complain when the Agency did not send a Locum-Registrar. We were left with just one Registrar, but the Consultant’s complaint amounted to nothing. Soon after this, a Resuscitation case came in – there was only the lone Registrar and the Consultant to look after that patient, leaving me to manage all the incoming Major cases by myself. And so it goes.

We have to work with what we have, there is no choice in the matter.  We have to keep going.

Whenever a patient’s relative stops me to ask for a glass of water, I simply have to grit my teeth and comply. What I really want to say is:

“Can’t you see that I’m the only doctor here? This is an Emergency Department!”

– Dr Bríd McGrath

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About the author:

Dr Brid McGrath

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